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Funded by an R21 grant from the National Institutes of Health, our research examines the validity of a virtual reality floor maze test that could help identify early signs of Alzheimer’s disease.
Getting lost in familiar spaces can be one of the earliest and most alarming indications of Alzheimer’s disease. With the help of virtual reality technology, this warning sign could soon be used as an opportunity for early diagnosis, too.
Funded by the National Institutes of Health, our study of a virtual reality floor maze test could identify an accessible, non-invasive opportunity to identify Alzheimer’s disease early in the preclinical phase, when treatment is most effective.
A progressive brain disorder caused by damage to nerve cells, Alzheimer’s disease is a type of dementia and one of the leading causes of death in the U.S. About 6.9 million people in the U.S. lived with the condition in 2020. The U.S. Centers for Disease Control and Prevention estimates that number will double to nearly 14 million by 2060.
Existing tests for Alzheimer’s disease, including PET scans and biomarker tests of cerebrospinal fluid, tend to be invasive, expensive, and difficult to access, especially for patients in rural areas.
Symptoms of Alzheimer’s disease can include problems with cognition, including memory loss, difficulty completing familiar tasks, and trouble with spatial navigation. People may get lost in their environment even before they have other signs of cognitive decline.
Our study explores the validity of a virtual reality floor maze that could help spot spatial navigation symptoms of Alzheimer’s disease when irreversible nerve damage has just begun, giving patients the best chance at effective treatment.
Improving spatial navigation testing.
Spatial navigation is a complex skill that integrates visual perception, spatial orientation, learning, and memory information. These processes occur in the brain’s medial temporal lobe, where Alzheimer’s disease first causes damage.
Existing spatial navigation tests that use mazes have limitations.
Paper and pencil and computer-based tests don’t engage the multisensory process involved in spatial navigation. Plus, they can be limited by educational and cultural factors, such as being limited to one language, which can reduce their effectiveness.
Active navigation tests, in which a patient navigates a maze on the floor, provide better results. They integrate brain signals as patients physically move through the maze, and performance on these tests has been shown to predict future risk of developing cognitive impairment. Yet because patients can see the exit (called vista navigation), these tests don’t accurately simulate the full experience of navigating through space (known as environmental navigation). Plus, they’re time-consuming to lay out and challenging to change.
We think virtual reality technology can help.
We’ve used a commercially available VR headset and free software to create virtual floor mazes that can be easily changed, and they can include virtual walls so patients can’t always see the exit. This allows us great flexibility to present new maze challenges to patients and precisely track their movements within a safe 33-foot by 33-foot room outfitted with cameras.
We’re studying this method to determine whether the VR maze tests can be effective and non-invasive and whether further testing is necessary to diagnose Alzheimer’s disease.
Related reading: Research: Spine-inspired Exosuit Could Help Relieve Low Back Pain.
Studying the validity of a VR floor maze test.
In this study, we’re enrolling participants over age 65, including people with mild cognitive impairment. They will navigate four mazes representing two types of navigation (vista and environmental)) and two types of exploration (walking and keyboard):
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Environmental navigation: VR maze with walls
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Vista navigation: VR maze without walls
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Walking exploration: Completing the VR maze while walking in real space
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Keyboard exploration: Completing the VR maze while seated using a keyboard
Before each maze, participants will see the course and plan their route. After completing each maze, participants will be asked to wait 10 minutes before trying again without a chance to prepare.
We’ll monitor how long each maze takes to finish neurological tests to learn about their brain function. We’ll observe how their brain works using functional near-infrared spectroscopy while they’re at rest and navigating the maze, and we’ll analyze their gait using trackers attached to their ankles and hips.
With all this data, we’ll seek to learn:
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If the virtual reality floor maze test exposes differences in navigation performance with or without walls and with and without walking
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If the test can help differentiate between levels of risk of cognitive decline
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How floor maze test results relate to participants’ performance on neurological tests
If the VR maze test proves valid, it could help patients with early Alzheimer’s better understand their cognitive future, and it could have benefits in detecting other conditions, too, including traumatic brain injury, Parkinson’s disease, and autism.
Innovating for tomorrow.
We’re enrolling participants with mild cognitive impairment at MedStar Franklin Square Medical Center in partnership with Dr. Gary Volkell. Participating in clinical trials can allow patients to get advanced care before it’s available to the public, and your involvement can help shape science and healthcare for future generations.
To learn more or enroll, contact Clinical Research Coordinator Cynthia Yashinski.
We believe the virtual reality floor maze test can help more people get essential information about potential cognitive decline. Critically, these tests may be able to show evidence of decline earlier, allowing more patients an opportunity for effective treatment that can slow the progression of Alzheimer’s disease.
